In vitro fertilization (IVF) is a complicated combination of procedures designed to improve fertility, avoid genetic abnormalities, and aid in childbirth. 

During IVF, mature eggs are extracted from the ovaries and fertilized in a laboratory using sperm. The fertilized egg (embryo) or eggs (embryos) are then placed in the uterus. A whole IVF cycle takes roughly three weeks. When these processes are divided into sections, the procedure might take longer.

The most effective kind of assisted reproductive technology is IVF. The treatment can be performed with the couple's own eggs and sperm. Alternatively, IVF may use eggs, sperm, or embryos from a known or anonymous donor. A gestational carrier, or someone who has an embryo implanted in their uterus, may be employed in some instances. 

Many variables influence your odds of having a healthy baby with IVF, including your age and the cause of infertility. Furthermore, IVF can be time-consuming, costly, and intrusive. IVF can result in a pregnancy with more than one fetus if more than one embryo is implanted to the uterus (multiple pregnancy).

Our experts can explain how IVF works, the dangers involved, and if this way of treating infertility is suitable for you.

Why is it done? 

In vitro fertilization (IVF) is a method of treating infertility or genetic disorders. If IVF is used to treat infertility, you and your spouse may be able to try less intrusive treatment options first, such as fertility medicines to enhance egg production or intrauterine insemination – a process in which sperm are inserted directly in the uterus near the time of ovulation. 

IVF is sometimes recommended as a main therapy for infertility in women over the age of 40. If you have specific medical issues, IVF can also be performed. For example, if you or your partner suffers from:

- Fallopian tube injury or obstruction: Damage or obstruction of the fallopian tubes makes it difficult for an egg to be fertilized or an embryo to move to the uterus. 

- Ovulation disorders: When ovulation is irregular or missing, there are fewer eggs accessible for fertilization. 

- Endometriosis: Endometriosis occurs when tissue identical to the uterine lining implants and develops outside of the uterus, frequently interfering with the function of the ovaries, uterus, and fallopian tubes. 

- Fibroids in the uterus: Fibroids are uterine tumors that are not cancerous. They are frequent among women in their thirties and forties. Fibroids can obstruct the implantation of a fertilized egg.

- Tubal sterilization or removal in the past: Tubal ligation is a method of sterilization that involves cutting or blocking the fallopian tubes to permanently prevent conception. If you want to get pregnant after tubal ligation, IVF may be a better option than tubal ligation reversal surgery. 

- Sperm production or function is impaired: Poor sperm motility, low sperm concentration, or abnormalities in sperm size and shape might make it difficult for sperm to fertilize an egg. If abnormalities in the sperm are discovered, a visit to an infertility expert may be required to determine whether there are any correctable issues or underlying health concerns. 

- Unknown cause of infertility: Unexplained infertility indicates that no cause of infertility has been identified despite testing for typical reasons.

- A genetic condition: If you or your spouse are at risk of passing on a genetic condition to your baby, you may be a candidate for IVF-based preimplantation genetic testing. After the eggs have been retrieved and fertilized, they are checked for genetic issues, albeit not all genetic disorders may be detected. Embryos that do not have any known abnormalities can be transplanted to the uterus.

- Fertility preservation in the case of cancer or other medical disorders: If you are going to begin cancer treatment that may affect your fertility, such as radiation or chemotherapy, IVF for fertility preservation may be a possibility. Women can have their eggs removed from their ovaries and frozen unfertilized for future use. Alternatively, the eggs might be fertilized and saved as embryos for later use. 

Women who do not have a functioning uterus or for whom pregnancy offers a significant health risk may choose for IVF with another person carrying the fetus (gestational carrier). The woman's eggs are fertilized with sperm in this situation, but the resultant embryos are implanted in the gestational carrier's uterus.

Risks 

IVF risks include: 

- Births in multiples: If more than one embryo is transplanted to your uterus through IVF, the possibility of multiple births increases. Pregnancy with multiple fetuses is associated with a greater risk of premature labor and low birth weight than pregnancy with a single fetus. 

- Premature birth with a low birth weight: According to research, IVF marginally increases the likelihood of the baby being born prematurely or with a low birth weight. 

- Syndrome of ovarian hyperstimulation: Injectable fertility medicines, such as human chorionic gonadotropin (HCG), can cause ovarian hyperstimulation syndrome, which causes your ovaries to become enlarged and uncomfortable. Mild stomach discomfort, bloating, nausea, vomiting, and diarrhea are common symptoms that last around a week. However, if you get pregnant, your symptoms may linger for several weeks. Rarely, a more severe type of ovarian hyperstimulation syndrome can occur, causing rapid weight gain and shortness of breath.

- Miscarriage: Miscarriage rates for women who use IVF with fresh embryos are similar to those for women who conceive naturally — 15% to 25% — but the incidence rises with maternal age. 

- Complications with the egg-retrieval technique: The use of an aspirating needle to retrieve eggs may result in hemorrhage, infection, or injury to the intestine, bladder, or a blood vessel. Sedation and general anesthesia, if utilized, pose additional risks. 

- Ectopic pregnancy: An ectopic pregnancy occurs in around 2% to 5% of IVF patients, when the fertilized egg implants outside the uterus, generally in a fallopian tube. The fertilized egg cannot survive outside of the uterus, thus the pregnancy cannot be continued.

- Defects during birth: The mother's age is the greatest risk factor in the development of birth abnormalities, regardless of how the kid is conceived. More study is needed to establish whether kids born through IVF are more likely to have certain birth abnormalities. 

- Cancer: Although early research revealed a relationship between some drugs used to increase egg formation and the development of a certain kind of ovarian tumor, more current research contradicts these findings. Following IVF, there does not appear to be a significantly increased risk of breast, endometrial, cervical, or ovarian cancer.

- Stress: IVF treatment can be financially, physically, and emotionally taxing. Counselors, family, and friends can provide support to you and your partner as you navigate the ups and downs of infertility therapy.

How do you prepare? 

Individual pregnancy and live birth rates at U.S. clinics are available online from the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology. 

The success rate of a clinic is determined by a variety of factors. These include the ages and medical conditions of the patients, as well as the clinic's treatment population and treatment procedures. Inquire about the charges involved with each phase of the operation in detail. 

Before commencing an IVF cycle using your own eggs and sperm, you and your spouse will most likely need a variety of testing, including:

- Ovarian reserve evaluation: Your doctor may test the concentrations of follicle-stimulating hormone (FSH), estradiol (estrogen), and anti-mullerian hormone in your blood during the first few days of your menstrual cycle to evaluate the amount and quality of your eggs. The findings of the tests, which are frequently combined with an ultrasound of your ovaries, can help anticipate how your ovaries will respond to reproductive medicine. 

- Analysis of sperm: If a semen analysis was not performed as part of your original fertility evaluation, your doctor will do one shortly before the commencement of an IVF treatment cycle.

- Screening for infectious diseases:. You and your companion will get tested for infectious illnesses such as HIV. 

- Experiment with (mock) embryo transfer: A mock embryo transfer may be performed by your doctor to establish the depth of your uterine cavity and the procedure most likely to effectively insert the embryos into your uterus. 

- Examine the uterus: Before you begin IVF, your doctor will inspect the uterine lining. A sonohysterogram (in which fluid is injected through the cervix into your uterus) and an ultrasound to produce pictures of your uterine cavity may be used. It might also entail a hysteroscopy, which involves inserting a thin, flexible, lighted telescope (hysteroscope) through your vagina and cervix into your uterus.

Consider the following questions before starting an IVF cycle:

How many embryos will be implanted?
The number of embryos transferred is usually determined by the age of the patient and the number of eggs retrieved. Because older women have a lower implantation rate, more embryos are normally transplanted — unless they use donor eggs or genetically verified embryos. 

Most physicians adhere to strict standards in order to avoid higher order multiple pregnancy, such as triplets or more. In certain countries, the number of embryos that can be transplanted is limited by law. Before the transfer operation, make sure you and your doctor agree on the number of embryos to be transplanted.

What are you going to do with any surplus embryos? 
Extra embryos can be frozen and preserved for several years for future use. Although most embryos will survive the freezing and thawing process, not all will. 

Having frozen embryos can reduce the cost and invasiveness of future IVF cycles. You might even give any unused frozen embryos to another couple or a research center. You may also decide to reject any unused embryos.

How will you deal with several pregnancies?
IVF can result in a multiple pregnancy if more than one embryo is transplanted to your uterus, which poses health hazards to you and your infants. Fetal reduction can be utilized in some situations to help a woman birth fewer infants with fewer health hazards. However, pursuing fetal reduction is a serious decision with ethical, emotional, and psychological ramifications.

Have you considered the potential risks of using donor eggs, sperm, or embryos, or a gestational carrier?
A trained counselor with expertise in donor issues can assist you in understanding the concerns, such as the donor's legal rights. An attorney may also be required to file court papers to assist you in becoming the legal parents of an implanted embryo.

What to anticipate  

Ovarian stimulation, egg retrieval, sperm retrieval, fertilization, and embryo transfer are all steps in the IVF process. A single IVF cycle can take two to three weeks. It is possible that more than one cycle will be required. 

Ovulation stimulation 

An IVF cycle begins with the use of synthetic hormones to stimulate the ovaries to produce multiple eggs rather than the single egg that develops each month. Because some eggs will not fertilize or develop normally after fertilization, multiple eggs are required. 

Several medications may be used, including:

Ovarian stimulation medications: You may be given an injectable medication containing follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of the two to stimulate your ovaries. These medications stimulate the development of more than one egg at a time. 

Oocyte maturation medications: When the follicles are mature enough for egg retrieval, which usually takes eight to fourteen days, you will be given human chorionic gonadotropin (HCG) or other medications to help the eggs mature. 

Preventing premature ovulation with medications: These drugs keep your body from releasing developing eggs too soon.

Preventing premature ovulation with medications: These drugs keep your body from releasing developing eggs too soon. 

Medications to prepare your uterine lining: Your doctor may advise you to start taking progesterone supplements on the day of egg retrieval or at the time of embryo transfer to make the lining of your uterus more receptive to implantation. 

-> Our doctors will collaborate with you to determine which medications to take and when. 

Typically, one to two weeks of ovarian stimulation is required before your eggs are ready for retrieval. You may have the following options for determining when the eggs are ready for collection:

- Vaginal ultrasound is an imaging exam of your ovaries used to track the growth of follicles, which are fluid-filled ovarian sacs where eggs mature. 

- Blood tests will be performed to assess your response to ovarian stimulation medications. As follicles develop, estrogen levels rise, while progesterone levels remain low until after ovulation. 

Sometimes IVF cycles must be canceled prior to egg retrieval for one of the following reasons: 

- Inadequate number of developing follicles
- Premature ovulation
- Too many developing follicles, increasing the risk of ovarian hyperstimulation syndrome
- Other medical issues

If your cycle is canceled, our doctors may advise you to change medications or their dosages in order to achieve a better response during future IVF cycles. You might also be recommended that you need an egg donor.

Egg retrieval 

Egg retrieval can be done 34 to 36 hours after the final injection and before ovulation in your doctor's office or a clinic. 

- You will be sedated and given pain medication during the egg retrieval procedure. 

- The most common method of retrieval is transvaginal ultrasound aspiration. To identify follicles, an ultrasound probe is inserted into your vagina. The eggs are then extracted by inserting a thin needle into an ultrasound guide and passing it through the vagina and into the follicles. 

- If your ovaries cannot be reached via transvaginal ultrasound, an abdominal ultrasound may be used to guide the needle. 

- The eggs are extracted from the follicles using a needle attached to a suction device. In about 20 minutes, multiple eggs can be removed.

- Cramping and feelings of fullness or pressure may occur after egg retrieval. 

- Mature eggs are incubated in a nutritive liquid (culture medium). Healthy and mature eggs will be combined with sperm in an attempt to create embryos. However, not all eggs will be fertilized successfully. 

Sperm Extraction 

If you're using your partner's sperm, you must provide a sperm sample at your doctor's office or clinic the morning of egg retrieval. Masturbation is commonly used to collect sperm samples. Testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — is sometimes required. Donor sperm can also be used. In the lab, sperm is separated from the sperm fluid.

Fertilization 

Fertilization can be accomplished in two ways: 

- Traditional insemination: Healthy sperm and mature eggs are mixed and incubated overnight during conventional insemination. 

- Injection of sperm intracytoplasmically (ICSI): ICSI involves injecting a single healthy sperm directly into each mature egg. ICSI is frequently used when sperm quality or quantity is an issue, or when fertilization attempts during previous IVF cycles have failed.

-> In some cases, your doctor may advise you to undergo other procedures prior to embryo transfer. 

- Hatching with assistance: An embryo "hatches" from its surrounding membrane (zona pellucida) about five to six days after fertilization, allowing it to implant into the uterine lining. If you're an older woman or have had multiple failed IVF attempts, your doctor may recommend assisted hatching, which involves making a hole in the zona pellucida just before transfer to help the embryo hatch and implant. Because the process can harden the zona pellucida, assisted hatching is also beneficial for previously frozen eggs or embryos.

- Genetic screening prior to implantation: After five to six days of development, embryos are placed in an incubator and allowed to develop until a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes. Embryos with affected genes or chromosomes cannot be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood of a parent passing on a genetic problem, it cannot completely eliminate the risk. Prenatal testing may still be advised.

Embryo transfer 

Embryo transfer is normally performed at your doctor's office or a clinic two to five days after egg retrieval. 

- You may be given a light sedative. The treatment is normally painless, however you may suffer slight cramping. 

- The doctor will implant a catheter, which is a long, thin, flexible tube, into your vagina, cervix, and uterus. 

- A syringe holding one or more embryos suspended in a little volume of fluid is linked to the catheter's end. 

- The doctor inserts the embryo or embryos into your uterus using a syringe. 

If all goes well, an embryo will implant in the lining of your uterus around six to ten days following egg extraction.

Following the process 

You can continue your normal daily activities after the embryo transfer. Your ovaries, however, may still be big. Consider avoiding strenuous exercise that may cause pain. 

Common side effects include: 

- Passing a tiny amount of clear or red fluid early after the operation - as a result of the cervix swabbing prior to embryo transfer
- Breast discomfort due to elevated estrogen levels
- Mild bloating
- Mild cramps
- Constipation 

Contact your doctor if you experience moderate or severe discomfort following the embryo transfer. He or she will assess you for issues such as infection, ovarian torsion, and severe ovarian hyperstimulation syndrome.

Results 

Your doctor will analyze a sample of your blood 12 to two weeks following egg retrieval to see if you're pregnant. 

If you're expecting a child, your doctor will send you to an obstetrician or another pregnancy expert for prenatal care. 

If you are not pregnant, you will discontinue progesterone and will most likely get your period within a week. Contact your doctor if you don't receive your period or if you have unusual bleeding. If you want to try another cycle of in vitro fertilization (IVF), your doctor may recommend actions you may take to increase your chances of getting pregnant through IVF. 

The likelihood of having a healthy baby after utilizing IVF is determined by a number of factors, including:

- Age of the mother: The younger you are, the more probable it is that you will become pregnant and have a healthy kid using your own eggs through IVF. Women over the age of 41 are frequently advised to consider utilizing donated eggs during IVF to boost their chances of success. 

- Status as an embryo: Transferring more mature embryos is related with greater pregnancy rates than transferring less developed embryos (day two or three). Not all embryos, however, survive the growth process. Discuss your unique circumstances with your doctor or other health care professional.

- History of reproduction Women who have previously given birth are more likely than women who have never given birth to become pregnant with IVF. Women who have previously done IVF numerous times but did not become pregnant have decreased success rates. 

- The reason behind infertility: Having a normal egg production boosts your chances of becoming pregnant during IVF. Those with severe endometriosis are less likely to be successful with IVF than women with unexplained infertility.

- Factors of living: Women who smoke had fewer eggs recovered during IVF and are more likely to miscarry. Smoking reduces a woman's chances of success with IVF by 50%. Obesity might reduce your chances of becoming pregnant and having a child. Alcohol, recreational drugs, excessive coffee, and some prescriptions can all be hazardous.

Discuss any issues that pertain to you and how they may impact your chances of a successful pregnancy with our doctors.

By Recmed's Medical Experts